High-Risk Chief Complaints I: Chest Pain-The Big Three (an Update).

  title={High-Risk Chief Complaints I: Chest Pain-The Big Three (an Update).},
  author={Benjamin Bautz and Jeffrey I. Schneider},
  journal={Emergency medicine clinics of North America},
  volume={38 2},

The Radiologist as a Gatekeeper in Chest Pain

CT scanners allow the exclusion of diagnoses such as coronary artery disease and aortic pathology, thereby reducing the patient’s stay in hospital and safely selecting patients by distinguishing those who do not need further treatment from those who will need more- or less-invasive therapies.

Performance of Prehospital use of Chest Pain Risk Stratification Tools: The RESCUE Study.

  • J. StopyraA. Snavely S. Mahler
  • Medicine
    Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
  • 2022
The combination of a paramedic-obtained HEAR score and PERC evaluation performed best to exclude 30-day MACE and PE but was not sufficient for directing prehospital decision making.

Incidence and outcomes of acute high-risk chest pain diseases during pregnancy and puerperium

The incidence of acute high-risk chest pain diseases, especially PE in puerperium, increased consistently and mortality has shown a downward trend, while no such up-trend was found in valvular disease and metastatic cancer.

Novel Blood Biomarkers for a Diagnostic Workup of Acute Aortic Dissection

The data suggest that IL-10 shows potential to be a rule-in biomarker for AAD and the addition of PAI1 and IL-6 to hs-TnT and D-dimers may improve the discrimination of suspected AAD, AMI, and PE in patients presenting with acute chest pain.

Nomogram to differentiate between aortic dissection and non-ST segment elevation acute coronary syndrome: a retrospective cohort study.

A predictive nomogram is developed that could be used as a tool to differentiate AD from NSTE-ACS rapidly and accurately and demonstrated a good consistency between the actual clinical results and the predicted outcomes.



Diagnosis of Aortic Dissection in Emergency Department Patients is Rare

The number of total ED and atraumatic chest pain patients for every aortic dissection diagnosed by emergency physicians is determined and it is found that an emergency physician seeing 3,000 to 4,000 patients a year would diagnose an aorti dissection approximately every three to four years.

Acute chest pain in the emergency room. Identification and examination of low-risk patients.

The difficulty of identifying patients at low risk for myocardial infarction or unstable angina in the emergency room without consideration of many factors from the history, the physical examination, and the ECG is emphasized.

Chest pain in the emergency room: value of the HEART score

  • A. SixB. BackusJ. Kelder
  • Medicine
    Netherlands heart journal : monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation
  • 2008
The HEART score is an easy, quick and reliable predictor of outcome in chest pain patients and facilitates accurate diagnostic and therapeutic choices.

Effect of Using the HEART Score in Patients With Chest Pain in the Emergency Department

The aim was to determine whether use of the HEART score results in reduced burden of care, hospitalizations, and health care costs but no increase in the occurrence of adverse cardiac events.

Utility of the History and Physical Examination in the Detection of Acute Coronary Syndromes in Emergency Department Patients

The review of the evidence clearly demonstrates that “atypical” symptoms cannot rule out ACS, while “typical’ symptoms cannotrule it in, and clinicians must strongly consider the need for further investigation with ECG and troponin measurement.

Clinical Features of Emergency Department Patients Presenting with Symptoms Suggestive of Acute Cardiac Ischemia: A Multicenter Study

It can be concluded that certain clinical features can help to identify ED patients with ACI, and normal ECGs were more frequently associated with a non-ACI final diagnosis, yet 20% of AMI patients and 37% of Unstable Angina Pectoris (UAP) patients had normal ECG.